MEDICARE: ALICIA TABISH JONES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	7641755-1205	UT

General Provider Information

NPI Number	:	1528121779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA TABISH JONES M.D.

Provider Business Mailing Address
First Line	:	9600 S 1300 E STE 230
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-3766
Country	:	US
Telephone Number	:	801-571-7777
Fax Number	:	801-523-1848

Provider Business Practice Location Address
First Line	:	9600 S 1300 E
Second Line	:	SUITE 300
City	:	SANDY
State	:	UT
Zip	:	84094-3766
Country	:	US
Telephone Number	:	801-571-7777
Fax Number	:	801-523-1848

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	03/15/2019

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